Everything You Should Know About Breech Position

When it comes to pregnancy, there is a lot to think about and prepare for. One of the things that an expectant mother would be concerned about is the position of their baby in the womb. If your baby is in a breech position, it can raise questions and concerns. 

In this blog, we aim to provide you with everything you need to know about breech position so you can feel informed and be prepared. From the different types of breech positions, to the causes and delivery options, we've got you covered. For those, who are unaware of it, let us quickly get a glance of the breech position. 

What Is A Breech Position?

At the time of birth, most babies naturally make movements so that their head is positioned to come out of the vagina first. This head-first position is considered as the safest position for birth and is known as vertex presentation.¹ A breech baby, or breech birth is a condition when the baby’s feet, buttocks or both are positioned to come first out of the woman’s vagina. This position of the baby refers to the ‘breech presentation’. Statistics reveal that this could happen in around 4% of full-term pregnancies. ²

Therefore, a breech position may develop certain complications at the time of birth. Before we learn  more about these, let us discuss the phenomenon of baby’s head engagement and factors determining the cephalic or breech presentation.  

What Is Head Engagement?

In early stages of pregnancy, your baby moves freely to take a variety of positions. While you’re nearing your due date, your baby does not have much space inside the womb. Therefore, the movements lessen and the baby starts to move in the position for birth. As your body prepares for labor, the muscles in your pelvis slowly start to loosen up to make room for the baby to pass through the birth canal. Your baby’s head starts descending into the lower part of the uterus, moving further into the pelvis. We refer to the baby's head as being "engaged" once the wider part of the baby’s head enters the pelvis. ^3,4

When Does Engagement Happen?

Every pregnant woman has a different experience when it comes to engagement. During the first pregnancy, the engagement of the baby’s head usually happens a few weeks before the birth i.e. anytime between 34 to 38 weeks of pregnancy. For a second-time mom or those who’ve had children before, they may not experience the baby’s head engagement until the labor starts. ^3,4

Fetal Positions For Birth

Fetal presentation refers to the position of the baby inside the womb, while you move towards the end of your pregnancy. Though, there are several positions that a baby can take and each of these positions may give rise to different complications. The safest position considered for a baby’s birth is ‘Cephalic presentation’. Here, the baby has settled in a position of head-down near the exit (or birth canal), facing the mother’s back with the chin tucked to its chest. However, some babies don't get into the ideal cephalic position at the time of the birth. ^3,4

If your baby’s head has not engaged yet, there is no need to panic. It could also be a breech presentation that we’ll be discussing in detail below. ^3,4

Types Of Breech Positions?

There are different types of breech positions which includes:

Complete Breech

In this position, the baby is in a sitting position with the legs crossed in front of its body, its feet near to its bottom and buttocks pointing downwards and are closest to the birth canal. ^2,5

Footling Breech

Also known as incomplete breech, Footling breech is a position when one or both the baby’s feet are below the buttocks. Therefore, one or both the feet comes out first. ^2,5

Frank Breech

In this position, buttocks aim at vagina, the baby’s legs are sticking right straight in front of the body, almost near the face. ^2,5

What Causes A Breech Position?

There are no such factors determining a breech birth. Any pregnancy may lead to breech baby by the time of labor. However, breech presentation is more common in the following situations: ^2,6

• Early or premature baby
• Abnormal level of amniotic fluid (too much or too little)- baby has too much or not enough space to move around in the uterus
• Mother has abnormal shaped uterus
• Multiple gestation: If there is one or two babies (twins, triplets or multiples)
• Uterus shows abnormal growth of fibroids
• When there is placenta previa (placenta covers all or most part of the uterus opening) 

Let your doctor know where you feel the movements. Also, getting an ultrasound will help confirm if your baby is breech.

How Does A Breech Baby Affect Pregnancy?

Hey to-be-mothers! There is no need to worry as most of the breech babies are born healthy. Yes, there is a slight chance of risk involved for certain birth defects. During your pregnancy, the baby’s movements may feel a little different like a little lower kicks in the belly. Sometimes, a woman also feels a hard bump closer to her ribs; fret not, it’s your baby’s head that is pushing.

Usually vaginal delivery can be complicated if your baby is breech. Therefore, in most of the cases, Cesarean Birth (C section) is highly recommended. ¹

How Does A Breech Baby Affect Delivery?

By the end of 36 weeks of pregnancy, if your baby is breech, then most likely your birthing plan will change. It is seen that, due to risks involved, vaginal birth is a bit complicated. Therefore, planning a Cesarean birth is the safest option for the delivery. Although, there are some doctors who are confident in vaginal breech birth and they continue with it. ¹ 

How Is A Breech Baby Diagnosed?

Turning a breech baby could be difficult but definitely not impossible. If your baby doesn't turn to vertex position, then you’ll have the following options to treat a breech baby. Let’s discuss in detail.

External Cephalic Version (ECV)

It is the process of turning the breech baby inside the uterus. This method is performed by your healthcare provider at 36-37 weeks of pregnancy because the baby has enough space to move around. As the baby grows and becomes mature, there is no space left inside the uterus for the baby to move. The doctor applies firm yet gentle pressure on the woman’s abdomen in order to move the baby in the uterus to the head-first position. Generally, before doing ECV, an ultrasound is performed to see if the baby is breech and certain medications are also given to relax the uterus muscles. This improves the chances of turning the baby. Blood pressure and pulse rate is checked; the baby's heartbeat is monitored throughout the duration. 

After the procedure is done, a second ultrasound is performed to see if the baby has changed its position. This process shows a 50% success rate for those who had a natural, vaginal birth previously. ^6,7 

Panicking? The baby is still in breech position and ECV didn’t work. No need to worry, you can opt for Cesarean birth.

C-Section Birth

If your due date is approaching and your baby is in breech presentation, it is recommended that you opt for Cesarean birth. Discuss the pros and cons of this delivery option with your doctor and proceed with it. ⁶

Concluding Note

A breech position is a common occurrence during pregnancy where the fetus is positioned bottom- or feet-first instead of head-first in the uterus. It is important for expectant mothers to understand the causes, risks, and treatments for a breech position so that they make informed decisions for the health and safety of themselves and their baby. While some breech babies can be delivered vaginally, others may require a cesarean section. Ultimately, the best way to ensure a healthy delivery is to work closely with a healthcare provider and follow their recommendations.